Identification of the human Cytochrome P450 enzymes (P450s) responsible for metabolizing infigratinib to its pharmacologically active Metabolites, BHS697, and CQM157, and assessment of their in vitro inhibition of P450s and UDP-glucuronosyltransferases (UGTs).

Infigratinib, an oral FGFR inhibitor for advanced cholangiocarcinoma, yielded two active metabolites, BHS697 and CQM157, with similar receptor affinity. Our study characterized P450s that are responsible for the metabolism of infigratinib to its two major active metabolites, BHS697 and CQM157. In vitro inhibition of P450s and UGTs by infigratinib, BHS697 or CQM157 was further investigated. The unbound apparent Km values for metabolism of infigratinib to BHS697 by HLM, human recombinant CYP2C8, CYP2C19, CYP2D6 and CYP3A4 enzymes are 4.47, 0.65, 2.50, 30.6 and 2.08 µM, while Vmax values are 90.0 pmol/min/mg protein, 0.13, 0.027, 0.81, and 0.56 pmol/min/pmol protein, respectively. The unbound apparent Km value for metabolism of infigratinib to CQM157 by HLM is 0.049 µM, while the Vmax value is 0.32 pmol/min/mg protein respectively. In HLM, infigratinib displayed moderate inhibition of CYP3A4 and CYP2C19 and weak or negligible inhibition of other P450 isoforms. BHS697 exhibited weak inhibition of CYP2B6, CYP2C9, CYP2C19 and CYP3A4, and no inhibition of CYP2C8 and CYP2D6. CQM157 moderately inhibited CYP2C9 and CYP3A4, and weakly or negligibly inhibited other P450 isoforms. Regarding UGTs, infigratinib moderately inhibited UGT1A4 and weakly inhibited UGT1A1, respectively. BHS697 weakly inhibited UGT1A1. In contrast, CQM157 moderately inhibited both UGT1A1 and UGT1A4. Our findings provide novel insights into the metabolism of and potential DDIs implicating infigratinib.

Analyzing the relationship between the efficiency and safety of a turbo roundabout by the factor analysis method.

The construction of cities and economic development lead to more and more serious environmental pollution, and the concept of green and low-carbon city has been proposed. Therefore, a series of requirements have been put forward for transportation. CO and other pollutants will be produced in the exhaust of conventional fuel vehicles, which will seriously affect the urban environment, especially at intersections with large passenger and vehicle flows. When multiple roads, especially more than 4 roads, intersect on urban roads, traffic organization can usually be achieved by using a roundabout. However, due to the limited capacity of the conventional roundabout, with the rapid increase of the traffic volume, and there are many vehicles in the circle lane change and interweaving behavior. This has caused serious congestion at the roundabout, the significantly increase in pollutants emissions and the decline in air quality. As an unconventional design, the turbo roundabouts use canalized traffic to allowed drivers to select the appropriate lanes in advance depending on their destinations so that different lanes within the circle do not interfere with one another, which improves the safety of the intersection while ensuring capacity. The main purpose of this paper is to analyze the traffic efficiency and safety of the conventional roundabout scheme and turbo roundabout scheme for five-way intersections. Using VISSIM to simulate different forms of roundabout and analyzing the six selected evaluation indicators. The number of vehicles in different entrance lanes and the diameter of the circle are selected as sensitivity factors for sensitivity analysis. Finally, the factor analysis method (FAM) is used to classify the six indicators into two categories: traffic efficiency and traffic safety, so as to comprehensively evaluate the different schemes. The results show that the difference in performance between the two schemes was not significant at low traffic volumes. At high traffic volumes, the turbo roundabout was better than the conventional roundabout in terms of emissions, safety and throughput efficiency. CO emissions from vehicles on conventional roundabout are generally higher than those on turbo roundabout, up to 53.62%. Therefore, the turbo roundabout is more appropriate for heavy traffic conditions.

Design and implementation of an automatic nursing assessment system based on CDSS technology.

BACKGROUND: Various quantitative and quality assessment tools are currently used in nursing to evaluate a patient's physiological, psychological, and socioeconomic status. The results play important roles in evaluating the efficiency of healthcare, improving the treatment plans, and lowing relevant clinical risks. However, the manual process of the assessment imposes a substantial burden and can lead to errors in digitalization. To fill these gaps, we proposed an automatic nursing assessment system based on clinical decision support system (CDSS). The framework underlying the CDSS included experts, evaluation criteria, and voting roles for selecting electronic assessment sheets over paper ones. METHODS: We developed the framework based on an expert voting flow to choose electronic assessment sheets. The CDSS was constructed based on a nursing process workflow model. A multilayer architecture with independent modules was used. The performance of the proposed system was evaluated by comparing the adverse events' incidence and the average time for regular daily assessment before and after the implementation. RESULTS: After implementation of the system, the adverse nursing events' incidence decreased significantly from 0.43 % to 0.37 % in the first year and further to 0.27 % in the second year (p-value: 0.04). Meanwhile, the median time for regular daily assessments further decreased from 63 s to 51 s. CONCLUSIONS: The automatic assessment system helps to reduce nurses' workload and the incidence of adverse nursing events.

Mismatched Social Welfare Allocation and PM2.5-Related Health Damage along Value Chains within China.

Value chains have played a critical part in the growth. However, the fairness of the social welfare allocation along the value chain is largely underinvestigated, especially when considering the harmful environmental and health effects associated with the production processes. We used fine-scale profiling to analyze the social welfare allocation along China's domestic value chain within the context of environmental and health effects and investigated the underlying mechanisms. Our results suggested that the top 10% regions in the value chain obtained 2.9 times more social income and 2.1 times more job opportunities than the average, with much lower health damage. Further inspection showed a significant contribution of the "siphon effect"─major resource providers suffer the most in terms of localized health damage along with insufficient social welfare for compensation. We found that inter-region atmosphere transport results in redistribution for 53% health damages, which decreases the welfare-damage mismatch at "suffering" regions but also causes serious health damage to more than half of regions and populations in total. Specifically, around 10% of regions have lower social welfare and also experienced a significant increase in health damage caused by atmospheric transport. These results highlighted the necessity of a value chain-oriented, quantitative compensation-driven policy.

Could ecological restoration reduce income inequality? An analysis of 290 Chinese prefecture-level cities.

Ecosystem degradation and the serious wealth gap caused by rapid economic development have become problems that cannot be neglected during the progress of pursuing sustainable development and reducing income inequality in China. To determine whether ecological restoration such as vegetation cover could affect the income gap, we used data for 290 prefecture-level cities in China from 2007 to 2018 and analyzed the effect of ecological restoration on income inequality in China. In addition, we chose the year 2012 as a boundary and performed heterogeneity analysis to permit a detailed comparison of the variation in the effect over time. We found that ecological restoration can reduce income inequality in general, but this effect was not statistically significant until 2012. However, due to some practical obstacles (e.g., employment opportunities, educational attainment, social discrimination), reducing income inequality through ecological restoration will be a time consuming process and requires constant effort from the Chinese government and local managers such as funding green industries, providing more targeted technical training for the poor and social services for the rural migrant workers.

Assessment of cumulative cancer risk attributable to diagnostic X-ray radiation: a large cohort study.

OBJECTIVE: To assess the risk of cancer induced by diagnostic X-ray exposure in multiple radiological examinations and to explore the relevant influences to provide a reference for rational usage of X-ray examinations. METHODS: Data for all adult patients who underwent X-ray examinations from August 2004 to April 2020 in a general hospital was collected, including sex, age, primary diagnosis, and X-ray examination. Based on the Biological Effects of Ionizing Radiations report, age and sex and effective dose for a single X-ray examination were used to calculate the lifetime attributable risk (LAR). Patients whose cancer LAR values were in the top 5% were considered to have a high cancer risk; the factors influencing this status were explored by using multivariate logistic regression analyses. RESULTS: In total, 1,143,413 patients with 3,301,286 X-ray examinations were included. LARs of cancer incidence and death were < 0.2% and < 0.13% among 95% of patients and they were > 1% among 0.21% and 0.07% of patients. High risks of incidence and death were significantly associated with corrected exposure frequency (odds ratio [OR], 1.080 and 1.080), sex (OR, male vs. female, 0.421 and 0.372), and year of birth (OR, 1.088 and 1.054), with all p values < 0.001. Among 20 disease categories, congenital disease (OR, 3.792 and 4.024), genitourinary disease (OR, 3.608 and 3.202), digestive disease (OR, 3.247 and 3.272), and tumor disease (OR, 2.706 and 2.767) had the strongest associations with high risks of incidence and death (all p values < 0.001). CONCLUSIONS: Cancer risk induced by diagnostic X-ray examinations can be considered acceptable clinically. Patients having certain diseases are potentially at a relative higher risk due to recurrent examinations. KEY POINTS: • It was the first large-scale investigation of cumulative X-ray exposure in China, involving more than 3.3 million X-ray scans of all types of diagnostic X-ray examinations for about 1.1 million patients during the past 16 years. • The study revealed that the incidence risk of cancer induced by X-ray-related examinations was 0.01% on average, which was substantially lower than that of cancer induced by non-X-ray radiation. The risk could be considered acceptable clinically. • Patients having certain diseases were potentially at a relatively higher cancer risk due to recurrent X-ray examinations. The cumulative effect of X-ray exposure could not be ignored and was worthy of attention.

Nosocomial transmission and rearrangement of large resistance-virulence hybrid plasmids between two bacteremic ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae strains with low fitness cost.

OBJECTIVES: To characterize nosocomial transmission and rearrangement of the resistance-virulence plasmid between two ST11-K64 carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) strains (JX-CR-hvKP-10 and JX-CR-hvKP-9) with low fitness. METHODS: Phenotypic tests were used to assess the virulence of JX-CR-hvKP-10 and JX-CR-hvKP-9. Whole-genome sequencing was used to analyze JX-CR-hvKP-10 and JX-CR-hvKP-9 chromosomes and plasmids. Fitness and conjugation experiments were also conducted using these two CR-hvKP isolates. RESULTS: Phenotypic tests indicated that both JX-CR-hvKP-10 and JX-CR-hvKP-9 were multidrug-resistant and hypervirulent K. pneumoniae. Whole-genome sequencing and clinical information demonstrated that the super large resistance-virulence fusion plasmid pJX10-1 formed precisely by the fusion of pJX9-1 and pJX9-2 via the nosocomial transmission. Interestingly pJX9-1 itself was also a classic resistance-virulence fusion plasmid by way of the blaKPC-carrying resistance plasmid and pLVPK-like virulence plasmid. Compared with classic K. pneumoniae ATCC700603, fitness analysis revealed no significant difference in growth was observed between JX-CR-hvKP-10 and JX-CR-hvKP-9. CONCLUSION: Nosocomial transmission and rearrangement of a blaKPC-harboring plasmid and a pLVPK-like virulence plasmid with a low fitness cost in ST11 K. pneumoniae enhances drug resistance and virulence simultaneously. Thus, active surveillance of this hybrid plasmid is needed to prevent these efficient resistance-virulence plasmids from disseminating in hospital settings.

Treatment satisfaction with rheumatoid arthritis in patients with different disease severity and financial burden: A subgroup analysis of a nationwide survey in China.

BACKGROUND: Despite the recent advances in treatments for rheumatoid arthritis (RA), there are still unmet needs in disease outcomes. This study aimed to analyze the satisfaction with drug therapies for RA according to the levels of disease severity (patient-assessed) and proportions of treatment cost to household income. METHODS: This was a subgroup study of a cross-sectional study in patients with RA and their physicians. The patients were subdivided into different subgroups based on their self-assessed severity of RA and on the proportions of treatment cost to household income (<10%, 10-30%, 31-50%, and >50%). The Treatment Satisfaction Questionnaire for Medication version II was used to assess patients' treatment satisfaction. RESULTS: When considering all medications, effectiveness, convenience, and global satisfaction scores were lower in the severe and moderate RA subgroups than those in the mild and extremely mild RA subgroups (all P < 0.001). Effectiveness, side effects, and convenience scores were higher in the <10% subgroup compared to those in the >50% subgroup (all P < 0.05). Global satisfaction score was higher in the <10% subgroup than that in the 31% to 50% subgroup (F = 13.183, P = 0.004). For biological disease-modifying anti-rheumatic drugs, effectiveness and convenience scores were lower in the severe RA subgroup than those in the extremely mild RA subgroup (both P < 0.05). Convenience score was higher in the <10% subgroup compared to that in the 31% to 50% and >50% subgroups (F = 12.646, P = 0.005). Global satisfaction score was higher in the <10% subgroup than that in the 31% to 50% subgroup (F = 8.794, P = 0.032). CONCLUSION: Higher disease severity and higher financial burden were associated with lower patient satisfaction.

[Variation in Pollutant Concentrations and Correlation Analysis with the Vegetation Index in Beijing-Tianjin-Hebei].

Based on 2017 hourly air quality monitoring data, NDVI 16 d synthetic data, and socio-economic data, the air pollution characteristics of Beijing-Tianjin-Hebei were systematically analyzed, and its variation, normalized vegetation index, and the relationship between the index (NDVI) and its impact on socio-economic factors, were analyzed by linear regression analysis and a geographically weighted regression model. The conclusions are as follows:①The overall air pollution in the Beijing-Tianjin-Hebei region is characterized by high-level pollution over the southern plain areas and low-level pollution over the northern mountainous areas. The air pollution increases from north to south, and shows significant spatial heterogeneity. ②From the perspective of seasonal changes, the overall order winter > autumn > spring > summer is observed, and atmospheric pollution in the Beijing-Tianjin-Hebei region shows significant temporal heterogeneity. ③The concentrations of pollutants such as SO2, NO2, CO, PM2.5, and PM10 all have a negative correlation with the NDVI value. Assuming that natural conditions such as climate and topography are relatively consistent, the lower the NDVI value, the more obvious the interference of human activities, the more concentrated the industrial economy layout, and the greater the pollution emissions, the more significant the negative impact on air quality. ④The NDVI reflects the land use, population distribution, and industrial layout to a certain extent, and these factors directly or indirectly determine the level of air pollution emissions and thus indicate the pollution distribution characteristics of the region. ⑤The results of the GWR model calculation show that the higher the level of economic development, the better the correlation between the NDVI and socioeconomic factors, PM2.5, and other pollutant concentrations. The distribution of the NDVI can generally reflect the level of social and economic development. The distribution of the NDVI also correlates to the distribution of PM2.5 to a certain extent.

Realizing low-carbon development in a developing and industrializing region: Impacts of industrial structure change on CO2 emissions in southwest China.

China is undergoing rapid industrial structure change, resulting in great disparities in industrialization stages and CO2 emission patterns across regions. In this study, we focused on the southwest economic zone (including Chongqing, Sichuan, Guangxi, Yunnan, and Guizhou), which is in the middle-industrialization stage and aims to mitigate CO2 emissions during strategic industrial transformation. We applied a framework with refined indicators based on input-output analysis (IOA) and structural decomposition analysis (SDA) to characterize and quantify the impact of industrial structure change on CO2 emissions during 2002-2012. In this period, construction ranked first in CO2 emission due to relatively high-carbon production structure and increasing share in final demand, which increased construction related CO2 emissions. Furthermore, we found that diversification in development and competitive industries had different impacts on CO2 emission trends. Yunnan and Guizhou experienced a transition from light manufacturing to resource-related manufacturing; therefore, CO2 emissions in resource-related manufacturing showed an increasing trend due to the extensive production structure in the two provinces, while it showed a decreasing trend in the other three provinces. Moreover, Chongqing, Sichuan, and Guangxi showed an apparent expansion trend in machinery manufacturing and related CO2 emissions, driven by investment, final demand structure, and production structure changes. Meanwhile, this zone avoided large-scale CO2 emissions in these sectors through net imports, by making good use of geographical advantages and trade structure. The CO2 emissions of the service sectors showed increasing trends due to increasing proportions in consumption structure and final demand structure. Furthermore, this led to a transition from consumer services to producer services with expansion. Among the five provinces, Chongqing had the lowest-carbon development pattern, owing to its higher technical levels of manufacturing and relatively lower-carbon production structure, which could be a reference point for rapid low-carbon economic development under middle industrialization for the other provinces or regions with the similar industrial characteristics.

Assessment of the Preventive Effect Against Diabetic Cardiomyopathy of FGF1-Loaded Nanoliposomes Combined With Microbubble Cavitation by Ultrasound.

Acidic fibroblast growth factor (FGF1) has great potential in preventing diabetic cardiomyopathy. This study aimed to evaluate the preventive effect of FGF1-loaded nanoliposomes (FGF1-nlip) combined with ultrasound-targeted microbubble destruction (UTMD) on diabetic cardiomyopathy (DCM) using ultrasound examination. Nanoliposomes encapsulating FGF1 were prepared by reverse phase evaporation. DM model rats were established by intraperitoneal injection of streptozotocin (STZ), and different forms of FGF1 (FGF1 solution, FGF1-nlip, and FGF1-nlip+UTMD) were used for a 12-week intervention. According to the transthoracic echocardiography and velocity vector imaging (VVI) indexes, the LVEF, LVFS, and VVI indexes (Vs, Sr, SRr) in the FGF1-nlip+UTMD group were significantly higher than those in the DM model group and other FGF1 intervention groups. From the real-time myocardial contrast echocardiography (RT-MCE) indexes, the FGF1-nlip+UTMD group A and A×ß showed significant differences from the DM model group and other FGF1 intervention groups. Cardiac catheter hemodynamic testing, CD31 immunohistochemical staining, and electron microscopy also confirmed the same conclusion. These results confirmed that the abnormalities, including myocardial dysfunction and perfusion impairment, could be suppressed to different extents by the twice weekly FGF1 treatments for 12 consecutive weeks (free FGF1, FGF1-nlip, and FGF1-nlip+UTMD), with the strongest improvements observed in the FGF1-nlip+UTMD group. In conclusion, the VVI and RT-MCE techniques can detect left ventricular systolic function and perfusion changes in DM rats, providing a more effective experimental basis for the early detection and treatment evaluation of DCM, which is of great significance for the prevention of DCM.

Survey using incognito standardized patients shows poor quality care in China's rural clinics.

Over the past decade, China has implemented reforms designed to expand access to health care in rural areas. Little objective evidence exists, however, on the quality of that care. This study reports results from a standardized patient study designed to assess the quality of care delivered by village clinicians in rural China. To measure quality, we recruited individuals from the local community to serve as undercover patients and trained them to present consistent symptoms of two common illnesses (dysentery and angina). Based on 82 covert interactions between the standardized patients and local clinicians, we find that the quality of care is low as measured by adherence to clinical checklists and the rates of correct diagnoses and treatments. Further analysis suggests that quality is most strongly correlated with provider qualifications. Our results highlight the need for policy action to address the low quality of care delivered by grassroots providers.

Evaluation of the effects of comprehensive reform on primary healthcare institutions in Anhui Province.

BACKGROUND: In 2009, the Chinese Central Communist Party and the China State Council started to implement comprehensive healthcare reforms. The first round of reforms, involving Anhui province, was from 2009 to 2011, and focused on primary healthcare institutions. This study conducts an initial assessment of the effects of specific parts of the reforms in Anhui. METHODS: Mixed quantitative and qualitative methods were adopted for data collection. Seven hundred and three health institutions from 15 counties were randomly chosen. The practices, development, effects, problems, and other relevant information related to the reform were classified into four aspects: medicine management; personnel systems and income distribution mechanisms; compensation mechanisms for primary healthcare institutions; and strengthening the primary healthcare system. The effects of reform were analyzed by evaluating changes in compensation channels, visit costs, diagnosis and treatment structure, hardware, structures, efficiency, and behavior. RESULTS: A new system for authorizing drugs resulted in a total of 857 new drugs being accessible at agreed prices through primary healthcare institutions in Anhui. The cost of the average outpatient visit decreased from 35.29 RMB to 31.64 RMB, although for inpatients, the average cost increased from 799.05 RMB to 992.60 RMB. The number of healthcare personnel decreased, but their workloads increased. The total revenue from government sources increased by 41.09%, and the proportion of revenue from drugs decreased by 25.19%. The rate of diagnosis and treatment visits and outpatient visits to primary healthcare institutions increased. Finally, between 2008 and 2010, 1,195 standardized township hospitals, 14,134 village clinics, and 1,234 community health service institutions were constructed. CONCLUSION: The reform of primary healthcare institutions in Anhui has improved the personnel structures surrounding frontline healthcare workers, increased their incomes, improved work efficiency, and changed the compensation patterns of primary healthcare institutions, improved hardware, reduced drug prices, and, to some extent, improved the diagnosis and treatment structure. However, the reforms have not radically changed the behavior of medical workers or the visit patterns of patients. Approaches such as strengthening performance evaluation, and carrying out initiatives to further mobilize frontline healthcare workers, enhance rational drug use through improved training and educate patients, should be undertaken in the future.

[Source and health risk assessment of heavy metals in ambient air PM10 from one coking plant].

To investigate the sources and health risk of heavy metals in ambient air PM10 from the coking plant, the PM10 in the air around one coking plant was collected in June 2012. Then the heavy metals concentrations in PM10 were tested by the microwave-ICP-MS method. Furthermore, the USEPA's human exposure assessment model was applied to preliminarily evaluate the human health risks of the heavy metals in air particulate matter. The results show that the concentrations of 10 kinds of heavy metals in PM10 from the coking plant vary significantly, ranging from 3.06 x 10(-5) mg x m(-3) to 1.77 x 10(-2) mg x m(-3), of which the concentration of Cr is the highest, while the concentration of Co is the lowest, and the concentration of the carcinogenic substances is higher than that of the non-carcinogenic substances. The coking plant is identified to be the major source of the heavy metals in ambient air PM10, and Ni is the main polluting heavy metal. Moreover, the heavy risk assessment results reveal that the carcinogenic risks for adults are higher than children, while the carcinogenic risks in industrial areas and school relatively large. The non-carcinogenic risks for children are the highest in all the population, and the non-carcinogenic risks in residential area can not be ignored. Among the carcinogenic substances, the potential carcinogenic risks of Cd, Cr and As are comparatively large, Ni and Co have certain potential risks. Whereas, among the non-carcinogenic substances, the non-carcinogenic risks of Mn is great. Consequently, relevant departments should pay close attention to this situation.

One-year outcomes of out-of-hospital administration of intravenous glucose, insulin, and potassium (GIK) in patients with suspected acute coronary syndromes (from the IMMEDIATE [Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency Care] Trial).

The Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency care Trial of very early intravenous glucose-insulin-potassium (GIK) for acute coronary syndromes (ACS) in out-of-hospital emergency medical service (EMS) settings showed 80% reduction in infarct size at 30 days, suggesting potential longer-term benefits. Here we report 1-year outcomes. Prespecified 1-year end points of this randomized, placebo-controlled, double-blind, effectiveness trial included all-cause mortality and composites including cardiac arrest, mortality, or hospitalization for heart failure (HF). Of 871 participants randomized to GIK versus placebo, death occurred within 1 year in 11.6% versus 13.5%, respectively (unadjusted hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.57 to 1.23, p = 0.36). The composite of cardiac arrest or 1-year mortality was 12.8% versus 17.0% (HR 0.71, 95% CI 0.50 to 1.02, p = 0.06). The composite of hospitalization for HF or mortality within 1 year was 17.2% versus 17.2% (HR 0.98, 95% CI 0.70 to 1.37, p = 0.92). The composite of mortality, cardiac arrest, or HF hospitalization within 1 year was 18.1% versus 20.4% (HR 0.85, 95% CI 0.62 to 1.16, p = 0.30). In patients presenting with suspected ST elevation myocardial infarction, HRs for 1-year mortality and the 3 composites were, respectively, 0.65 (95% CI 0.33 to 1.27, p = 0.21), 0.52 (95% CI 0.30 to 0.92, p = 0.03), 0.63 (95% CI 0.35 to 1.16, p = 0.14), and 0.51 (95% CI 0.30 to 0.87, p = 0.01). In patients with suspected acute coronary syndromes, serious end points generally were lower with GIK than placebo, but the differences were not statistically significant. However, in those with ST elevation myocardial infarction, the composites of cardiac arrest or 1-year mortality, and of cardiac arrest, mortality, or HF hospitalization within 1 year, were significantly reduced.

Exploring China's materialization process with economic transition: analysis of raw material consumption and its socioeconomic drivers.

China's rapidly growing economy is accelerating its materialization process and thereby creating serious environmental problems at both local and global levels. Understanding the key drivers behind China's mass consumption of raw materials is thus crucial for developing sustainable resource management and providing valuable insights into how other emerging economies may be aiming to accomplish a low resource-dependent future. Our results show that China's raw material consumption (RMC) rose dramatically from 11.9 billion tons in 1997 to 20.4 billion tons in 2007, at an average annual growth rate at 5.5%. In particular, nonferrous metal minerals and iron ores increased at the highest rate, while nonmetallic minerals showed the greatest proportion (over 60%). We find that China's accelerating materialization process is closely related to its levels of urbanization and industrialization, notably demand for raw materials in the construction, services, and heavy manufacturing sectors. The growing domestic final demand level is the strongest contributor of China's growth in RMC, whereas changes in final demand composition are the largest contributors to reducing it. However, the expected offsetting effect from changes in production pattern and production-related technology level, which should be the focus of future dematerialization in China, could not be found.

Comprehensive assessment of the association between tumor necrosis factor alpha G238A polymorphism and liver cancer risk.

Tumor necrosis factor alpha (TNF-α) has been suggested to play an important role in the development and liver cancer. TNF-α 238 G/A polymorphism was hypothesized to increase the risk of liver cancer, but findings from previous studies were controversial. To explore a more precise estimation of the relationship between TNF-α 238 G/A polymorphism and liver cancer, we performed a meta-analysis. PubMed, Embase, and China Biology Medicine databases were searched for all publications on this association through March 12, 2013. Odds ratios (ORs) with its 95% confidence intervals (CIs) were used to assess the strength of this association. Eleven studies with 1,406 liver cancer cases and 2,386 noncancer controls were included into this meta-analysis. Overall, there was a significant association between TNF-α 238 G/A polymorphism and increased risk of liver cancer under all three genetic models (A vs. G, OR 1.51, 95% CI 1.20-1.89, P < 0.001, I(2) = 37.7%; AG vs. GG, OR 1.49, 95% CI 1.01-2.21, P = 0.045, I(2) = 53.2%; AA/AG vs. GG, OR 1.76, 95% CI 1.35-2.30, P < 0.001, I(2) = 36.5%). The sensitivity analysis further strengthened the validity of the positive association. Subgroup analysis of nine studies from Asian countries showed that there was a significant association between TNF-α 238 G/A polymorphism and increased risk of liver cancer in Asians (A vs. G, OR 1.35, 95% CI 1.03-1.76, P = 0.027, I(2) = 40.2%; AA/AG vs. GG, OR 1.56, 95% CI 1.14-2.15, P = 0.006, I(2) = 41.9%). In conclusion, TNF-α 238 G/A polymorphism is significantly associated with increased risk of liver cancer, especially in Asians.

Community health service capacity in China: a survey in three municipalities.

RATIONALE: China is reforming its health care system. It aims to strengthen primary health care through building community health facilities and assigning a 'gate-keeper' role to primary care providers. However, it remains unknown whether community health facilities are able to fulfil such a mission. This study evaluated the service capacity of a selected sample of community health facilities and the competency of primary care practitioners employed by those facilities. METHODS: Three municipalities from the east, middle and west of China were purposely selected. A questionnaire was undertaken in 45 randomly selected community health facilities in the three municipalities and 700 primary care practitioners responded to the survey. The survey investigated the capacity of the community health facilities in providing diagnostic services and the competency of the primary care providers in handling common health problems. RESULTS: The most common reasons for doctor-patient encounters were common cold and chronic diseases. The capacity of the community health facilities in providing diagnostic services was limited. Although the majority of respondents believed that they could correctly identify common symptoms, many were unable to perform some essential physical examinations. CONCLUSION: The community health facilities are not able to fulfil their designated mission because of the limited diagnostic capacity and poor competency of the primary care practitioners. Priorities should be given to capacity building for the development of community health services in the future.

Cardiovascular assessment of fetal mice by in utero echocardiography.

To establish a developmental profile of fetal mouse cardiovascular parameters, we analyzed a large body of ultrasound measurements obtained by in utero echocardiography of C57BL/6J fetal mice from embryonic day 12.5 to 19.5 (term). Measurements were obtained using two-dimensional (2D), spectral Doppler and M-mode imaging with standard clinical cardiac ultrasound imaging planes. As these studies were conducted as part of a large scale mouse mutagenesis screen, stringent filtering criteria were used to eliminate potentially abnormal fetuses. Our analysis showed heart rate increased from 190 to 245 beats per minute as the mouse fetus grew from 8 mm at embryonic day 12.5 to 18.7 mm at term. This was accompanied by increases in peak outflow velocity, E-wave, E/A ratio and ventricular dimensions. In contrast, the A-wave, myocardial performance index and isovolemic contraction time decreased gradually. Systolic function remained remarkably stable at 80% ejection fraction. Analysis of intra- and interobserver variabilities showed these parameters were reproducible, with most comparing favorably to clinical ultrasound measurements in human fetuses. A comprehensive database was generated comprising 23 echocardiographic parameters delineating fetal mouse cardiovascular function from embryonic day 12.5 to term. This database can serve as a standard for evaluating cardiovascular pathophysiology in genetically altered and mutant mouse models.